Aural Hab Final

Cultural competence

the ability to understand, appreciate, and interact with people from cultures or beliefs systems different from there own

Cultural Humility

takes competence a step further and is “self reflection and discovery in order to build honest and trustworthy relationships

Medical perspective for deafness

Views deafness as a hearing condition to be identified and treated through medical interventions such as hearing aids, cochlear implants, and auditory rehabilitation.

What is the cultural perspective of deafness?

Views Deaf individuals as members of a linguistic and cultural minority rather than people with a disability.

What is the bilingual perspective?

Supports learning both ASL and spoken/written English, recognizing benefits of bilingual language development

What is the social perspective of deafness?

Focuses on removing environmental and societal barriers instead of trying to "fix" the individual. Accessibility and inclusion are emphasized.

Which perspective should professionals adopt?

Respect all perspectives while providing families with unbiased, evidence-based information so they can make informed decisions

Person first language vs. identity first language

student who is deaf vs deaf student

Which language should clinicians use?

Use the individual's preferred terminology whenever possible.

Which terms are no longer recommended?

• Hearing impaired

• Failed hearing screening

• Multiply disabled (when referring to Deaf individuals)

Preferred terms

• Deaf or hard of hearing (D/HH)

• Hearing difference

• Referred (instead of failed)

• Identified (instead of diagnosed when discussing newborn hearing screening)

What is aural habilitation?

Services that develop listening, spoken language, speech, and communication skills for individuals who are Deaf/HH.

Which professionals participate in aural habilitation?

• Speech-language pathologists

• Audiologists

• Teachers of the Deaf

• Other interdisciplinary team members

What does an SLP contribute to aural habilitation?

• Speech production

• Language development

• Communication skills

• Literacy

• Social communication

• Family education

What does an audiologist contribute?

• Hearing evaluations

• Hearing aids

• Cochlear implant management

• Hearing technology fitting

• Listening assessments

What are the five conditions for effective collaboration?

1. Equal contributions

2. Shared goals

3. Shared responsibility

4. Shared accountability

5. Shared resources

What factors influence language outcomes?

• Cause of hearing difference

• Age of identification

• Degree of hearing difference

• Hearing technology

• Consistency of technology use

• Early intervention quality

• Home language environment

• Communication modality

• Family involvement

• Student personality

• Additional disabilities

Why does early identification matter?

Earlier identification allows earlier intervention, which generally leads to stronger language outcomes.

How does the home language environment affect outcomes?

Language-rich environments support stronger communication development regardless of communication modality.

What are the major language areas commonly affected in children who are Deaf/HH?

• Vocabulary (semantics)

• Phonology

• Morphology

• Syntax

• Pragmatics

• Literacy

• Higher-level language (inferencing, abstract language)

What speech characteristics are commonly affected?

• Prosody

• Voice quality

• Nasality

• Pitch

• Articulation (depending on auditory access)

What are the levels of listening development?

• Detection

• Pattern perception

• Word identification

• Sentence comprehension

• Running speech comprehension

What is the overall goal when working with Deaf/HH individuals?

Provide person-centered, culturally humble, collaborative, evidence-based services that maximize communication access while respecting each individual's identity, preferences, and strengths.

What structures make up the outer ear?

pinna (auricle)

auditory canal (ear canal)

Middle ear structures

• Tympanic membrane

• Malleus

• Incus

• Stapes

• Eustachian tube

What structures make up the inner ear?

• Cochlea

• Hair cells (stereocilia)

• Auditory nerve

• Vestibular system

Function of outer ear

Collects and funnels sound waves toward the tympanic membrane (eardrum)

Function of middle ear

Amplifies sound vibrations and transfers them to the inner ear.

Function of inner ear

Converts sound vibrations into electrical nerve impulses sent to the brain.

Function of hair cells

Hair cells convert mechanical vibrations into electrical signals.

Function of the cochlea

Separates sounds by frequency and stimulates hair cells that send information to the auditory nerve

Conductive hearing loss

A problem in the outer or middle ear that prevents sound from reaching the inner ear.

Common causes of conductive hearing loss

• Ear infections

• Fluid

• Atresia

• Earwax

• Perforated eardrum

Sensorineural hearing loss

Damage to the inner ear (hair cells) or auditory nerve.

Causes of sensorineural hearing loss

• Genetics

• Noise exposure

• Aging

• CMV

• Syndromes

Why is speech harder to understand with sensorineural hearing loss?

Hair cell damage reduces both:

• Loudness

• Clarity of sound

What is normal hearing loss

0–20 dB HL

Mild hearing loss

20–40 dB HL

Moderate hearing loss

40–70 dB HL

Severe hearing loss

70–90 dB HL

What is profound hearing loss?

90+ dB HL

What is an air-bone gap?

A difference of 10 dB or more between air conduction and bone conduction thresholds.

Indicates conductive hearing loss.

What are behavioral hearing tests?

Tests requiring an active response.
Raise hand

• Push button

• Repeat words

• Conditioned play audiometry

• Pure-tone audiometry

What is speech recognition testing?

Measures how well a person understands speech, not just detects it.

What are physiological hearing tests?

Tests measuring body responses rather than behavioral responses.

Examples:

• Tympanometry

• OAE

• ABR

• Acoustic reflexe

What does tympanometry measure?

Middle ear function

What does a Type B tympanogram indicate?

• Middle ear fluid

• Perforated eardrum

What are OAEs?

Otoacoustic emissions.

Measure cochlear (hair cell) function.

Frequently used in newborn hearing screening.

What is abr?

Auditory Brainstem Response.

Measures hearing through brain activity.

Often used with infants.

How do you determine the type of hearing loss?

Compare air conduction and bone conduction.

Normal bone + air-bone gap = Conductive

Both abnormal + no gap = Sensorineural

Both abnormal + gap = Mixed

How can mild hearing loss affect school?

Difficulty hearing:

• Soft speech

• Distant speech

• Classroom discussions

How can moderate hearing loss affect school?

May miss:

• Classroom instruction

• Peer conversations

• Vocabulary

• Morphology

Often needs amplification.

How can severe/profound hearing loss affect school?

Significant impact on:

• Spoken language

• Literacy

• Academic learning

Often requires multiple communication supports.

What classroom factors make listening harder?

• Distance

• Noise

• Reverberation

• Poor acoustics

• Multiple speakers

What accommodations may be needed?

• FM/HAT systems

• Captioning

• Preferential seating

• Interpreter

• Visual supports

• Note-taking assistance

Who is a candidate for hearing aids?

Students with:

• Mild to severe hearing loss

• Conductive or sensorineural hearing loss

Who is a candidate for a cochlear implant?

Students with:

• Bilateral severe to profound

• Sensorineural hearing loss

• Limited benefit from hearing aids

How does a cochlear implant work?

The sound processor:

1. Collects sound

2. Converts it into an electrical code

3. Sends the signal through the transmitter coil

4. Stimulates the cochlea through an electrode array

Who is a candidate for a bone conduction device?

Students with:

• Conductive hearing loss

• Atresia

• Single-sided deafness

How does a bone conduction device work?

The processor changes sound into vibrations that travel through the skull directly to the cochlea.

Signal delivered:
Bone vibration (tactile signal)

What should school personnel monitor daily?

• Device is worn

• Device is functioning

• Ling Six Sound Check

• Basic troubleshooting

Ling Sound test

Sit behind the child
Do the six sounds and have them repeat: /mm/, /oo/, /ee/, /ah/, /sh/, and /ss/

Examples of HAT

• FM systems

• Roger microphone

• Bluetooth systems

What are the benefits of HAT?

• Better speech understanding

• Improved access in noisy classrooms

• Reduced listening effort

• Reduced listening fatigue

• Consistent teacher signa

Why are visuals important

They supplement auditory information and improve access to instruction.

Examples of visual supports

• Sign language

• Captioning

• Written directions

• Pictures

• Graphic organizers

• Visual schedules

• Gestures

• Demonstrations

• Interpreter

T/F Students often benefit from multiple communication supports

True

What is the MAIS?

A parent interview measuring how well a child uses hearing in everyday life.

What does the MAIS measure?

• Device use

• Alertness to sound

• Meaningful responses to sound

• Everyday listening behaviors

Who completes the MAIS?

Parents/caregivers through structured interview questions.

What is the Auditory Skills Checklist?

A developmental checklist that identifies a child's current listening level and guides therapy planning.

What listening hierarchy does the Auditory Skills Checklist assess?

• Detection

• Patterning

• Discrimination

• Identification

• Comprehension

What does the CASLLS do?

Tracks developmental progress in:

• Listening

• Spoken language

• Speech

Used for children with hearing loss.

What is spice?

Speech Perception Instructional Curriculum and Evaluation

Assesses speech perception skills and helps plan listening instruction.

Why use a sound level meter?

To measure classroom background noise and determine whether the environment supports listening.

What classroom noise level is recommended?

30 dB or less

What signal-to-noise ratio (SNR) is recommended?

Teacher's voice should be at least +15 dB louder than background noise.

How does distance affect listening?

Every time the distance doubles, the speech signal decreases by about 6 dB.

What classroom factors increase cognitive load?

• Fast pace

• Background noise

• Distance

• Complex vocabulary

• Multiple speakers

• Figurative language

• Following directions

• Poor acoustics

Common classroom accommodations for students who are Deaf/HH

• Preferential seating

• HAT/FM system

• Captioning

• Visual supports

• Interpreter

• Teacher faces student

• Check understanding

• Written directions

• Extra processing time

• Reduced background noise

• Note-taking support

What is Early Hearing Detection and Intervention (EHDI)?

EHDI is a coordinated system designed to:

• Screen infants for hearing differences

• Complete diagnostic audiologic testing promptly

• Connect identified children and families with early intervention services

• Support access to appropriate hearing technology, communication options, and trained professionals

Early identification is especially important because the first three years are a period of maximum plasticity for the central auditory pathways

What is the EHDI 1-3-6 guideline?

• Screen by 1 month

• Confirm or identify hearing status by 3 months

• Begin appropriate early intervention by 6 months

What is family-centered practice?

An approach in which professionals work in partnership with families, respect family priorities, and support caregivers as important decision-makers and facilitators of their child’s development.

What is the role of the family in auditory-verbal intervention?

The family is considered the child’s primary source of language learning. Parents and caregivers are coached to promote listening and spoken language throughout everyday activities and routines.

How is coaching different from simply telling a parent what to do?

Coaching is collaborative and hands-on. The professional supports the caregiver in practicing, reflecting on, and independently using strategies in real-life situations.

Professionals must be able to model strategies and coach parents in using them appropriately.

What is the basic auditory skill hierarchy?

• Detection

• Discrimination

• Identification

• Comprehension

What question does detection answer?

“Did you hear something?”

What are early signs that a child detects sound?

The child may:

• Turn toward a sound

• Stop moving

• Widen their eyes

• Smile

• Vocalize

• Point to their ear

• Place an object in a container after hearing a sound

What is an activity for auditory detection?

Wake up the animal: Hide a toy animal and make a sound. The child wakes or moves the animal only after detecting the sound.

What question does discrimination answer?

“Do these sound the same or different?”

How should discrimination targets progress?

Begin with sounds that are very different and gradually move toward sounds that are increasingly similar.

Activities for discrimination

Present a long sound and a short sound, such as:

• “Mmmmm”

• “Pop!”

The child indicates whether the sounds are the same or different or matches each sound to a different toy.

What question does identification answer?

“What did you hear?”

Closed-set identification activity

Place three familiar objects in front of the child. Say one object’s name without pointing, and have the child select it.

Open-set identification activity

Say a word or phrase without providing answer choices. The child repeats or tells what was heard.

What question does comprehension answer?

“What does the message mean, and how should I respond?”

Activities for auditory comprehension

give directions

answer wh questions

inferencing activitiues

Auditory-Verbal strategies

• wait time

• acoustic highlighting

• auditory sandwich (auditory only, auditory w/ visual, auditory only(

• auditory closure (begin familar song or phrase then let them finish)

• listen first

• auditory memory

How are auditory skills connected to language development?

Auditory skills allow a child to detect, distinguish, recognize, remember, and understand spoken language. Challenges at any of these levels can affect the development of:

• Semantics

• Phonology

• Morphology

• Syntax

• Pragmatics